1,721,322 research outputs found
A systematic review of the cost-effectiveness of peginterferon alfa-2b in the treatment of chronic hepatitis C
No full textA systematic review was conducted of the full economic evaluations of the cost-effectiveness of peginterferon alfa-2b (PEG-IFN alfa-2b) plus ribavirin (RBV) in the treatment of chronic hepatitis C (CHC). A total of 439 references were screened and 11 studies were included. The studies employed decision analytic Markov models in which hypothetical cohorts of patients progressed through a series of health states characteristic of the natural history of CHC. The studies analyzed various regimens of PEG-IFN alfa-2b plus RBV including stopping rules for different genotypes, and fixed or weight-based dosing of RBV. In all studies, PEG-IFN alfa-2b plus RBV was associated with favorable incremental cost-effectiveness ratios (ICERs) when compared with IFN plus RBV. Tailored treatment according to bodyweight dosing and circumscribed treatment for different genotypes improves ICERs further. Further cost-effectiveness analyses should consider the impact of antiviral treatment in subgroups of patients including those co-infected with HIV, hemophiliacs and patients who are retreated following previous treatment failure, where data are available
An economic evaluation of school-based skills building behavioural interventions of preventing sexually transmitted infections in young people
No full textRegulating Interior Designers
Full text linkRegulating Interior DesignersRegulating Interior DesignersAlexander, Adrienne; Henjum, Chris; Jones, Jeremy; Luger-Nikolai, Meg; Rosenberger, Aaron; Smith, Carolyn. (2009). Regulating Interior Designers. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/61691
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis
No full textBackground: Pre-eclampsia (PE) prediction based on blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities can result in false-positive diagnoses. This may lead to unnecessary antenatal admissions and preterm delivery. Blood tests that measure placental growth factor (PlGF) or the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to PlGF could aid prediction of PE if either were added to routine clinical assessment or used as a replacement for proteinuria testing.Objectives: To evaluate the diagnostic accuracy and cost-effectiveness of PlGF-based tests for patients referred to secondary care with suspected PE in weeks 20–37 of pregnancy.Design: Systematic reviews and an economic analysis.Data sources: Bibliographic databases including MEDLINE, EMBASE, Web of Science and The Cochrane Library and Database of Abstracts of Reviews of Effects were searched up to July 2015 for English-language references. Conferences, websites, systematic reviews and confidential company submissions were also accessed.Review methods: Systematic reviews of test accuracy and economic studies were conducted to inform an economic analysis. Test accuracy studies were required to include women with suspected PE and report quantitatively the accuracy of PlGF-based tests; their risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. The economic studies review had broad eligibility criteria to capture any types of economic analysis; critical appraisal employed standard checklists consistent with National Institute for Health and Care Excellence criteria. Study selection, critical appraisal and data extraction in both reviews were performed by two reviewers.Economic analysis: An independent economic analysis was conducted based on a decision tree model, using the best evidence available. The model evaluates costs (2014, GBP) from a NHS and Personal Social Services perspective. Given the short analysis time horizon, no discounting was undertaken.Results: Four studies were included in the systematic review of test accuracy: two on Alere’s Triage® PlGF test (Alere, Inc., San Diego, CA, USA) for predicting PE requiring delivery within a specified time and two on Roche Diagnostics’ Elecsys® sFlt-1 to PlGF ratio test (Roche Diagnostics GmbH, Mannheim, Germany) for predicting PE within a specified time. Three studies were included in the systematic review of economic studies, and two confidential company economic analyses were assessed separately. Study heterogeneity precluded meta-analyses of test accuracy or cost-analysis outcomes, so narrative syntheses were conductedto inform the independent economic model. The model predicts that, when supplementing routine clinical assessment for rule-out and rule-in of PE, the two tests would be cost-saving in weeks 20–35 of gestation, and marginally cost-saving in weeks 35–37, but with minuscule impact on quality of life. Length of neonatal intensive care unit stay was the most influential parameter in sensitivity analyses. All othersensitivity analyses had negligible effects on results.Limitations: No head-to-head comparisons of the tests were identified. No studies investigated accuracy of PlGF-based tests when used as a replacement for proteinuria testing. Test accuracy studies were found to be at high risk of clinical review bias.Conclusions: The Triage and Elecsys tests would save money if added to routine clinical assessment for PE. The magnitude of savings is uncertain, but the tests remain cost-saving under worst-case assumptions. Further research is required to clarify how the test results would be interpreted and applied in clinical practice.Study registration: This study is registered as PROSPERO CRD42015017670.Funding: The National Institute for Health Research Health Technology Assessment programme
Omalizumab for previously treated chronic spontaneous urticaria
No full textUrticaria (also known as hives, welts or nettle rash) is a vascular reactioncharacterised by the transient appearance of raised, itchy lesions ('wheals')on the skin. It occurs when histamine and other chemicals are released from under the surface of the skin, causing tissues to swell. The lifetime prevalence of chronic urticaria in the UK is 0.5 1%, but approximately 15% of people experience urticaria at some time in their lives. For many people with urticaria, the cause of their condition is unknown. Individual wheals can change size rapidly and move around the skin, disappearing in one place and then reappearing somewhere else on the body. They generally appear on the skin for no longer than 24 hours; however, the condition may persist for several months. Angioedema (swelling of lips, hands and feet) may also be present. When symptoms are present for more than 6 weeks, the condition is considered to be chronic. Symptoms may persist for 3 5 years in approximately 50% of people, and for more than 10 years in 20% of people. Initial treatment of chronic spontaneous urticaria is a non-sedating H1- antihistamine (for example, cetirizine, levocetirizine, fexofenadine, loratadine, bilastine, desloratadine). Dose escalation of the antihistamine (2-fold and then 4-fold) may be required if the standard dose is ineffective. Subsequent treatment options for people whose condition does not respond to non- sedating antihistamines include leukotriene receptor antagonists, H2-receptor antagonists, immunosuppressant drugs (such as ciclosporin, mycophenolate mofetil and methotrexate) and tetrahydrofolate dehydrogenase inhibitors (such as dapsone). Oral corticosteroid pulses may be used to treat exacerbations
Shortened peginterferon and ribavirin treatment for chronic hepatitis C
Full text linkBackground: Peginterferon alfa and ribavirin combination therapy is an effective treatment for many patients with chronic hepatitis C virus (HCV). Reducing the length of treatment may be advantageous. We performed a systematic review and economic evaluation to assess shorter treatment duration of this regimen.Methods: We searched fourteen bibliographic databases (including The Cochrane Library, Medline, and Embase) from 2000 to October 2009 and consulted experts and drug manufacturers. Eligible articles were randomized controlled trials (RCTs) selected according to predefined criteria. We undertook an economic evaluation to assess the cost-effectiveness of shortened treatment versus standard treatment in the UK.Results: Six trials were included. In the sub-group of patients who had low viral load (LVL) and a rapid virological response (RVR), there were no statistically significant differences in sustained virological response (SVR) rates between patients who received standard treatment (range, 83 percent to 100 percent) and those who received shortened courses (range 84 percent to 96 percent)(24 weeks for genotype 1, 16 weeks for genotype 2/3). Shortened treatment resulted in cost savings, but in some scenarios also resulted in poorer outcome, compared with standard treatment. This requires a judgment to be made on the value of the quality-adjusted life-year loss resulting from adopting a shorter treatment regimen, if shorter treatment is associated with a lower SVR than standard treatment duration.Conclusions: For chronic HCV patients who have LVL and achieve an RVR, shortened peginterferon and ribavirin combination therapy could be considered as a viable treatment option
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